The surgical approach to esophageal atresia repair and the management of long-gap atresia: results of a survey

The optimal approach for esophageal atresia (OA) repair and technique used for long-gap OA repair are controversial. There are few data comparing the outcomes of the different approaches and techniques. We performed a survey of current practice of 88 pediatric surgeons and asked experts to provide us with definitions and rationales behind their management strategies. There were no differences between UK and non-UK surgeons. Although the majority of pediatric surgeons perform minimally invasive surgery (68%), only 16% have performed thoracoscopic OA repair; however, 46% are planning to carry out thoracoscopic OA repair. Gastric interposition is the most preferred technique for long-gap OA when primary anastomosis is not possible, with 94% of those surgeons who use the technique satisfied with it. Growth of the esophageal ends by traction is the other major technique used, but only 76% of surgeons who use it are satisfied with it. Most surgeons repair ≤2 patients with long-gap OAs per year. Long-gap OA should be managed by a limited number of surgeons at each center. Even among experts, there is little consensus on the definition of or the optimum technique for repair of long-gap OA.